12 Years of Work on our Vision: Transforming to Meet the Needs of the Community

Last week, we held a Board retreat, and during the meeting, we showcased a video in which participants in the 2010 Board visioning retreat reflected on the work that has occurred over the past 12 years. The 2010 Board visioning retreat sent GBMC HealthCare in a new direction, and this video testimonial highlighted our commitment to building a system of care for the community.

In 2010, it was clear that the Greater Baltimore Medical Center was an excellent hospital with great clinicians, and Gilchrist was doing an excellent job with end-of-life care. But the Board recognized significant gaps. We did not have a true systematic approach to managing people with chronic disease or to prevent chronic disease. Patients were often left to connect their own care between office visits with their primary care physician and specialists and inpatient stays. The Board saw the need to create a true system of care that the patient would experience as a system. This notion required an accountability function, and the Board agreed with the adoption of the patient-centered medical home advanced primary care model.

The Board also realized that if the goal was to keep people out of the hospital, then adding more hospitals was not a necessary step. They also saw that relative smallness would make it easier to transform and maintaining local control will accelerate the rate of meaningful change. They therefore decided to retain our independence from multi-hospital companies.

Creating a system that the patient experiences as a system required a single medical record for each individual. So, we invested the resources in Epic.

So, what has this meant for our patients and the community?  The list of improvements is long! Advanced primary care has brought improvements in addressing behavioral health needs. All patients are screened for depression, and if they fail the screen, they are referred immediately to the behavioralist in the practice who works with the primary care provider to come up with a treatment plan right away. Our Sexual Assault Forensic Examination (SAFE) and Domestic Violence (DV) programs have totally redesigned the care for sexually or physically abused individuals who comes to our Emergency Department. We know precisely how many diabetic patients we have, and we work directly with each of them to keep their diabetes under control. We responded to the opioid epidemic and the mental health crisis by adding masters-prepared behavioralists, addiction specialists and psychiatrists to our patient-centered medical homes and by adding peer counselors to the Emergency Department to work with substance-addicted patients. Gilchrist added in-home primary care for frail elders who had difficulty coming to the advanced primary care centers. We built strong programs in palliative care and integrative care for symptom management to further improve our care of those with chronic disease. These are just a few of the powerful changes that we have made to our system to move us toward our vision of being the community-based true system of care that has the capability of managing the health of a population and of delivering to every patient, every time, the care that we want for our own loved ones.

I am so proud of the improvements we have made, and I am really excited about continuing toward our vision and extending our work to marginalized populations in the city of Baltimore.    

Congratulations are in Order!
I am proud to let you know that SIX of our colleagues were chosen by their peers from thousands of nurses in the Baltimore region. These phenomenal clinicians have been recognized as Baltimore magazine’s 2022 Excellence in Nursing winners! Please join me in congratulating the following nurses:
Evelyn Bowmaster, MAS, BSN, RN, CHPO, CPPS, Director of Quality & Patient Safety, Ambulatory Services
Rosalyn B., BSN, RN, FNE-A, FNE-P, SAFE Nurse and Domestic Violence Strangulation Liaison
Anne Conrad, MS, RN, CCRN, RN Care Manager
Pam G., MSN, RN, FNE-A/P, SANE-A, SANE-P, SAFE Nurse
Evette H., MA, BSN, BS, RN, FNE A/P, SAFE Nurse
JoAnn Parr, MSN, MS-HCM, RN, C, Director of Care Management and Continuing Care Services

Also, it's that time again when Baltimore magazine is collecting votes from area physicians for its “Top Doctors” issue. Docs, please vote for the colleagues you most respect! The survey is found here.

Thank You!
I want to thank everyone who participated in our seventh annual Walk a Mile in Their Shoes event. Please know that you can still log your miles and donate here until 11:59 p.m. this Saturday, April 30. 

Since we are still dealing with the COVID 19 pandemic, we again had in-person and virtual options for this event. We had approximately 300 participants, who walked close to 80,000 miles and helped us raise more than $100,000 for our SAFE and DV programs. I am proud that GBMC continues to be a leader in helping the victims of sexual assault and domestic violence and in educating the community to reduce these attacks. It is great to see the ongoing strong support of our community, and I am grateful for their commitment to the cause even during the pandemic. Walk a Mile in Their Shoes allows GBMC to provide these necessary services 24 hours a day, 7 days a week at no cost to our patients.

I want to thank the GBMC Foundation and all parties who worked together to make this year’s event another success!

Congratulations to our Compassionate Caregiver Award Winner! 
Congratulations to our 2021 Compassionate Caregiver Award winner, Cheryl Miles - Environmental Services, SICU!  Congrats also to the other finalists:
Jeffrey Alvarez, GNA – Sub Acute Unit 54
Sandy Rector, M-Div., BCC – Spiritual Support
Wendy Riggin, RRT – Respiratory Therapy
Kelly Truax – SAFE & Domestic Violence Program.
Click here to watch the award show!

Medical Laboratory Professionals Week
This week is Medical Laboratory Professionals Week. Our medical laboratory professionals work tirelessly to provide highly reliable evidence-based care to our patients. These behind-the-scenes heroes are essential members of the patient care team. We are very fortunate to have an outstanding team of pathologists, technicians, phlebotomists, and support staff who truly do their part to drive us toward our vision. I am so proud of our lab team who have always demonstrated excellence. Thanks to our lab personnel for all that they do!

Welcome to Maryland
Last week, it was announced that Mark T. Gladwin, MD, a leading heart, vascular, and lung physician-scientist, was named as the next dean of the University of Maryland School of Medicine (UMSOM). I want to congratulate Dr. Gladwin on his selection.

Rewarding & Recognizing

Not long ago, our Performance Improvement and Innovation (PII) team started the reward and recognition currency, Systems Change, to recognize both individuals and teams for behaviors and skills that support continuous improvement, teamwork, patient safety, and for embodying our GREATER values. The chart here explains it best.

GBMC’s core competency is redesigning care. This program rewards and recognizes individuals and entire teams for their dedication and contributions to delivering on our core competency.

Each quarter, the PII team selects a “change agent” who has a positive, collaborate attitude toward change, serves as an influencer for change in their department, is instrumental in problem solving, and has a passion for patient-centered improvements. 

This month, we are recognizing Kimberly Stewart, tray line associate in our Nutritional Services department, as our change agent. Kimberly recently created standard work that helped get food trays to patients in a more accurate and timely manner. In addition, she trained her colleagues in the new procedure and enrolled them in it. As a result of Kim’s work and her colleagues’ buy-in, the department saw an increase in their food temperature scores on the patient satisfaction survey. For more on this initiative and on Kim’s success, please visit here. Nice job, Kim, and congratulations to our Food Service team! 

Honoring our colleagues’ commitment to service
This week is National Volunteer Week, and each year we look forward to recognizing and thanking our wonderful volunteers and to honor their significant contributions. We are incredibly fortunate to have more than 300 active volunteers who generously contribute their time and talent to GBMC and our patients and are an integral part of the healthcare team.

The pandemic truly brought their service to our patients and their assistance to our staff into focus. During the height of the pandemic, GBMC paused our volunteer program to protect the health of our loyal volunteers.”

They were greatly missed, and we are grateful that they have returned. Their example of servant leadership is invaluable.

When you meet a GBMC or Gilchrist volunteer this week, please take the time to say “thank you” for all they do.

Hey, why don’t you take a walk!!
This Saturday, we are holding our seventh annual Walk a Mile in Their Shoes fundraiser. This year’s event is again a hybrid, with options for both in-person and virtual participation. 

This event, hosted by the GBMC Foundation, brings the community together to support and raise awareness for the Sexual Assault Forensic Examination (SAFE) and Domestic Violence (DV) program at GBMC. 

Our SAFE & DV program treats victims of all ages in a confidential setting. The unit has seen an overall increase in cases and severity of injury over the last year. Furthermore, our program is seeing its highest number of siblings coming in for treatment of child abuse. I am proud to say that we have the region’s most comprehensive sexual assault, sexual abuse, and domestic violence center, offering free victim services to patients. We are pleased with the impact our program is having, and we are grateful for all the community support that allows us to provide these necessary services across the region. 

So, please walk or run a mile (or more), in person this Saturday or virtually until the end of April and share the 2022 Miles Challenge with a friend or family member. Virtual participants can log their miles for free each day on the event website, or on social media by sending the keyword "WAM" to GBMC via Facebook Messenger or following @gbmchealthcare on Instagram and sending a private Instagram message with the keyword "WAM." With your help, we can reach our goal of 10,000 miles! As of today, we have now logged approximately 5,000 miles to support GBMC SAFE & DV! 

If you have not done so, you can register for the in-person walk on April 23,  even up to the day of the event. Anyone who registers at the $30 level between now and then will be automatically entered into a contest for a chance to win Paul McCartney tickets. Your registration gives you 5 chances to win. Each donation of $7 also gives you a chance to win.

Again, if you’re interested in participating in our virtual walk or want to donate to our SAFE and DV Program, it’s not too late! Please visit www.gbmc.org/WalkaMile for more details. Thank you! 

What a blast!!
Last Friday, I had the pleasure of watching this year’s World Voice Day Vocal showcase at GBMC. This was our third live World Voice Day show, watched in person by approximately 60 people and about 80 online viewers.

This employee-only event allows members of the GBMC workforce to display their singing talents. The concert included seven incredibly talented performers, who sang songs from multiple genres. I was really inspired with the great vocal talents from across our system.

This event also reminded me what a jewel we possess in the Johns Hopkins Voice Center (located in the Milton J. Dance, Jr. Head and Neck Center) on our medical campus.

For people who use their voice as a tool of the trade, being in tune with their "instrument" is crucial. When someone is diagnosed with a vocal disorder, it is life-altering and requires expert treatment, education and, at times, emotional support.

The Voice Center has treated thousands of patients, from a very wide geographic area. 

The Voice Center encompasses 5,000 square feet in patient treatment rooms along with a soundproof room — filled with acoustic amplifiers, a keyboard, guitars, and percussion instruments — to address the needs of individuals with vocal problems, including educators, litigators, politicians, motivational speakers, broadcasters, as well as professional, semi-pro and amateur singers, and even the occasional celebrity.  

I want to congratulate Dan Sherwood, MS/CCC-SP, HSE, our clinical vocologist at the Johns Hopkins Voice Center here at GBMC and his colleagues for their hard work in putting another great event together and to the staff of the Voice Center for their commitment to patient care. 

If you want to see the talent showcased at our recent event, please visit here. Congratulations to all!

What Do You Want in End-of-Life Care?

Tomorrow (Saturday, Apr.16) is National Healthcare Decisions Day – a nationwide initiative to raise awareness, educate, and empower healthcare providers and the public about advance care planning (ACP).

An advance care plan is a valuable document that provides an individual the opportunity to make your health care wishes known, when you cannot speak for yourself, and provides your family and loved ones a blueprint about the care you would like to receive should you become seriously ill. During the COVID-19 pandemic, advance care planning took on a sense of urgency for those who were older and most vulnerable to becoming seriously ill from the coronavirus. 

It is very important for all of us to select a health care representative to speak on our behalf when we cannot express our wishes. You should make sure that this representative, your family and physicians, know how you wish to be treated should you become very ill. An advance care document is an excellent way of assuring that physicians in all sites of care know the extent of care you would like to receive under certain circumstances.

Studies show that 75% of Americans would prefer to die at home surrounded by their loved ones. However, 75% of Americans are currently dying in the hospital. This suggests that many people are not making their wishes known to their family and their care providers. Creating a written document, an advance care plan, is a way to make your wishes known. 

For those who need healthcare decision maker forms, or Advance Directives (Five Wishes), or need help creating their living wills or information on how to appoint healthcare representatives, please email Tracie Schwoyer-Morgan, DNP, MS, ANP-BC, Manager of Advanced Care Management (middle) at tschwoyer-morgan@gilchristcares.org

Dedication of the Cleft Lip and Palate Program
Recently, we held a dedication ceremony honoring Dr. Randy Capone’s legacy of hope and his passion for others. As part of the commemoration, we officially renamed GBMC’s Cleft Lip and Palate Program The Randal B. Capone Cleft Lip and Palate Program.  

Prior to his passing in early 2019, as medical director of the program, Dr. Capone led the efforts of our cleft lip and palate team in being recognized by the American Cleft Palate-Craniofacial Association (ACPA), thus making us one of four hospitals in the state to receive this endorsement. The ACPA sets industry standards and optimizes the interdisciplinary care of persons affected by craniofacial abnormalities. This well-deserved recognition is only given to teams with the highest level of training. 

For those of you who knew Dr. Capone, you can understand the significance of renaming the program as he brought smiles and joy to his patients via his unique combination of warmth, intelligence, and surgical skill. 

Thanks to all who joined us in honoring Dr. Capone. 

Flag raising ceremony for Donate Life Month
April is Donate Life Month, which brings awareness to the need for organ and tissue donors and honors those who have donated. 

In tribute, we joined our partners from The Living Legacy Foundation of Maryland for a virtual flag-raising ceremony in honor of the donors and to celebrate their gifts of life to others.

According to recent statistics, more than 170 million people are registered organ, eye, and tissue donors; however, more than 100,000 people are waiting for life-saving organ transplants. In 2021, over 41,000 transplants from 20,300 donors brought renewed life to patients and their families and communities. 

Please remember that you have the power to save lives. Those wishing to register as an organ, eye, and tissue donor can do so at your local MVA or here. 

HerStor-ical Confirmation
In March, we celebrated Women’s History Month, and late last week, we saw the milestone confirmation of Judge Ketanji Brown Jackson to the U.S. Supreme Court, making her the first Black woman in U.S. history to reach the high court. This is a significant moment in our nation’s history that was long overdue. This is a major step forward our country has taken in making our Supreme Court more representative of the diversity of our nation. Congratulations to US Supreme Court Justice Ketanji Brown Jackson!

Happy Easter, Passover, and a Peaceful Ramadan
We have arrived at a time of year for religious reflection and celebration, and I would like to extend best wishes to our Christian staff members celebrating Easter this Sunday as well as our Jewish staff members observing the eight-day festival of Passover starting this Friday. 

I also want to extend those wishes to our Eastern Orthodox Christian colleagues who are celebrating their Holy Week starting this Sunday and our Muslim colleagues for a prayerful and peaceful Ramadan.

For GBMC staff members working during their spring holiday, special thanks for taking care of our patients. I am grateful for all your efforts.

A Sad Case Revisited

In May of 2019, I wrote a blog titled “A Word of Caution in Overriding at the Electronic Drug Dispensing Cabinet" after a Vanderbilt University Hospital nurse used the override function at a drug dispensing cabinet and gave a patient Vecuronium, a paralyzing agent, when she intended to give Versed, a sedative. The patient died. 

The case is back in the media because the nurse was found guilty of gross neglect and negligent homicide in the man’s death by a Tennessee criminal court. This is a tragedy and an ignorant decision. Healthcare has become much safer than it used to be by the reporting of medical errors and near misses so that they can be learned from and prevented. This case will stop many from reporting errors because of fear of retribution.

At GBMC, we follow the concept of just culture. In just culture, the only time that punishment is indicated is if the individual was consciously trying to harm someone or was knowingly breaking a rule that an individual in the same situation and organization would not have broken. In this case, the breaking of “the rule” is that overrides should not be used except in emergencies. 

What is the override function? Drug dispensing cabinetry takes advantage of computerization to only allow medication to be removed for a given patient if it is on the patient’s “profile.” To be on the profile, there has to be an order from a provider and a pharmacist verification that the order is appropriate. In the Vanderbilt case, it appears that nurses frequently used the override to move more quickly without waiting for the order from a provider to be put in the system and for it to be verified by the pharmacist. When the override is used, two steps of protection for the patient are removed.

We humans make mistakes, especially when we are rushing. Organizations that understand this build systems to catch the mistakes. That’s what the official order and pharmacy verification are all about. If nurses at a hospital get the message (even if it is indirect) that speed and efficiency are paramount, then they use the override to move faster. In many hospitals, nurses frequently use the override function in situations that are not emergencies. This nurse was the unlucky one who used it and took a medication that could kill someone, and it did. The nurse was immediately devastated once she learned what she had done. She already lost her license and now she may go to jail. I am sure that she will appeal the case, but this is not right and if the case is allowed to stand, it will have a chilling effect on patient safety. Stay tuned. 

Recognizing National Public Health Week
This week is National Public Health Week – an annual time to acknowledge the contributions of public health.

Public health departments and workers are responsible for laws requiring the use of seatbelts, guidelines protecting clean air and water, and laws against smoking in restaurants and bars.

The theme for this year is “Public Health is Where You Are,” and it recognizes that promoting and protecting health is important to the public and to local communities. It celebrates the idea that the places we are physically, mentally, and socially affect our health. This theme is more important now than ever because of what we have learned from pandemic.

So, if you run into a public health professional, thank him or her!

For more information on National Public Health Week click here.

Still learning…
Earlier this week, I was proud to participate in the 33rd Quest for Excellence Conference along with Carolyn Candiello, our Vice President for Quality and Patient Safety and a number of our senior leaders. We were present for the award ceremony honoring the Baldrige recipients from the past three years. This was the first award ceremony featuring three years of Baldrige achievers!

It was a great event as it brought the Baldrige community together again to not only celebrate but also to learn from each other.

The conference had approximately 50 speakers from all sectors sharing their insights, tools, and stories with close to 1,000 attendees from the business, education, health care, nonprofit and government sectors. There was much discussion about role model best practices from current and former award recipients in all Baldrige areas.

I want to congratulate all of the recipients for the last three years who achieved this monumental recognition!

If you want to learn more about our 2020 Baldrige recognition, please visit here.